Rate Transparency

Verify Payment Adherence and Compare Rates to Peers.

The Transparency in Coverage rule (2022) requires insurers to publicly disclose their negotiated rates—but these files are massive, unstandardized, and nearly impossible to navigate without specialized infrastructure. We built that infrastructure.

How We Use Transparency Data

At MedResolutions, transparency-in-coverage data is central to how we build winning IDR arguments. In IDR arbitration, arbiters are required to consider information beyond the Qualified Payment Amount (QPA), including offers, market data, and peer benchmarks. We mine the transparency files to identify what insurers are actually paying comparable providers in the same region for the same procedure codes—giving our arguments an evidence-based foundation that is difficult to refute.

But our use of this data extends well beyond IDR. We've built the capability to:

• Search Contracted Rates: Quickly look up what specific payers are paying for any CPT code, in any market—giving you instant visibility into the rate landscape.
• Generate Market Benchmarks: Build custom reimbursement benchmarks by specialty, geography, and procedure type using real negotiated-rate data across hundreds of payers.
• Compare Rates to Peers: See how your reimbursement compares to similarly situated providers in your region, and identify where you may be systematically underpaid.
• Verify Payment Adherence: Cross-reference insurer payments against their own disclosed contracted rates to confirm you're being paid what you're owed under your agreement.
• Generate Custom Data Pulls: We can produce bespoke data reports tailored to your practice's specific payers, procedures, and geographies—on demand.

Rate transparency is no longer just a regulatory checkbox—it's a strategic asset. MedResolutions turns one of the most complex datasets in healthcare into clear, actionable intelligence for your practice.